Category: Healthcare

Obamacare has been the Moby Dick to the Republicans’ Captain Ahab for almost a decade. Ever since the Democratic majority rammed the bill through reconciliation in 2009 – a process designed to limit votes and deliberation, as well as ensure passage in the Senate – the party has campaigned on replacing this gargantuan entitlement program.

And now, Moby Dick has surfaced and is in sight.

Campaigns in 2010, 2012, 2014, and 2016 all rested on the appeal of repealing Obamacare.

The historic 63 seat tidal wave of the 2010 election – based almost entirely on a campaign to repeal Obamacare — was galvanized by the nationwide Tea Party movement. It was a movement created in response to Obamacare, and who “primaried” Republicans who did not swear allegiance to repealing the dreaded law.

It was one of the many promises made by President Trump, as he crested the “Blue Wall” of midwestern states and won the White House.

The law itself is bankrupt… failing in state after state and with healthcare outcomes worsening for those who use it.

This would appear to be, on the surface, the easiest vote ever cast by any politician… ever!

And yet, we instead find ourselves at the precipice. Fighting amongst Republicans about whether it should be a combined bill, two separate bills, or the need to replace Obamacare at all, has created a dangerous moment where actual repeal is in jeopardy, as would be the 2018 mid-terms.

President Trump has most recently sided with the Rand Paul wing of the party, and has conceded that a “repeal” bill by itself with a “replace” bill separately voted on is the way to go. It is a political high-wire act with no net, as numerous big-ticket issues are happening around the world.

Should repeal and replace be voted on together or separately?

I. Three Reasons Repeal and Replace Should be Voted on Together:

Failure to have a ‘replace’ option attached could mean we never get it replaced at all. There is nearly unanimous support for repealing Obamacare, it has already passed the House 50+ times since 2011. But replacing it remains a political football between Republicans that want to go back to the pre-Obama years, and others who believe something must be done to fill in the gaps created by the elimination of Obamacare. Agreement on what a replacement bill looks like will be hard to come by, so forcing a combined vote is the only way the Republican leadership believes they can get the law repealed if at all. Give some congressmen some goodies—some pork to take back home—and you could coddle the votes together. Only vote on repeal, which means only taking away something from the voters, and congressmen recoil in fear.

The system is so badly compromised that without a replacement bill, government health insurance programs will go bankrupt as well. Obamacare may be bankrupt, but without a replacement bill, millions with pre-existing conditions lose their coverage. Medicaid cannot afford the expansion of those added to the rolls, and health insurance companies reliant upon government subsidy will have their budgets and business models upended. At least, that’s the argument. It is certainly probable that some insurers’ business models will fail, but a replacement bill is not needed to simply provide additional funds to Medicaid through the traditional congressional budget process. The free market can take care of the insurance industry. And there will be some legislative action on pre-existing conditions, regardless of a replacement bill… it is the one constituency and mandate from Obamacare that maintains broad public support.

The mid-terms will be a slaughter for Republicans if they repeal without replacing… they will own healthcare as an issue. It may have been easy to demonize the socialist Obamacare program, but now any change to the system will be perceived as belonging to the Republicans. Whether that is true or not is unprovable, but certainly a significant risk. Changing who is getting insurance, and how one receives health care, will be mercilessly assaulted in the mainstream media. Combined with the time it will take for the market to fix the disaster created by Obamacare, may not lead to electoral bliss for Republicans in 2018.

II. Three Reasons epeal and Replace Must be Voted on Separately:

No one campaigned on replacing Obamacare until recently. The original public response to Obamacare was repeal, not repeal and replace. You didn’t hear the term repeal and replace as a common mantra until 2015… 5 years after the Tea Party helped sweep the Republicans into the majority. And even then, it was a throw-away line for a limited number of candidates over the last few years. Repeal and replace gained some currency as a catch-phrase used by Trump in the Presidential campaign. But the driving force behind Trump’s victory had more to do on populist economics and the reversal of the Obama era, not replacing Obamacare.

The system worked before Obamacare. Before Obamacare, insurance markets were already straining under the burden of government regulations and limits on the sale across state borders. Nonetheless, 90% of the public had insurance, and 80% were happy with it. Increasing costs, copays, and premiums had people worried, but not to the point of wanting Obamacare passed. No one was dying in the streets in America, nor were they being denied some level of care. Bottom line, repeal without replacement takes us back to a marginally-based market system, which could then be improved with expanding Medicaid. But passing market-based measures such as selling insurance across state lines, tort reform, and expanding health savings accounts.

The votes aren’t there for a combined bill. Politics has a rhythm and momentum. It is clear there is not much momentum behind repeal and replace. However, repeal has the votes, by itself, today. Furthermore, failure to repeal the law would be a betrayal of the voters who gave the Republicans their nation-wide majority. For 6 years, to repeal Obamacare, all we heard on the campaign trail was “…we need the House.” After voters gave Republicans the House, they campaigned on the need to have the Senate. So, voters gave Republicans both the House and the Senate. Finally, Obamacare was still the law of the land, and politicians said: “…we need all three: House, Senate, and the White House.” And so, voters dutifully gave them all three. To betray the voters on Obamacare repeal now would seem to be a form of political suicide that would be unrecoverable. This would be a disaster for Republicans in the 2018 mid-term elections.

The moment of truth has arrived. Live up to the promise you gave voters and repeal Obamacare, or face the consequences in 2018. Let the market fix health insurance. Congress can deal with those in need after ridding the country of the scourge of Obamacare.

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